BackgroundDiabetes mellitus DM is a risk factor for early neurological deterioration END in acute ischemic stroke. The prothrombotic protein fibrinogen is frequently elevated in patients with diabetes, and may be associated with poorer prognoses. We evaluated whether fibrinogen is associated with END in patients with diabetes after acute ischemic stroke.

MethodsWe included 3814 patients from a single hospital database admitted within 72 h of onset of ischemic stroke. END was defined as an increase in the National Institutes of Health Stroke Scale NIHSS ≥2 within 7 days post-admission. In the total population END, n = 661; non-END, n = 3153, univariate and multivariate analyses were performed to assess fibrinogen as an independent predictor for END. We then performed propensity score matching and univariate analyses for DM END, n = 261; non-END, n = 522 and non-DM populations END, n = 399; non-END, n = 798. Multiple logistic analyses were performed after matching for fibrinogen as a risk factor in each subgroup.

ResultsFibrinogen levels were higher in the END group than in the non-END group 367 ± 156 mg-dL vs. 347 ± 122 mg-dL, p = 0.002, though they were not associated with END in logistic regression analyses. Fibrinogen levels were found to be an independent predictor for END, but only in the DM population fibrinogen levels 300–599 mg-dL, odds ratio: 1.618, 95% confidence interval: 1.037–2.525, p = 0.034, fibrinogen levels ≥600 mg-dL, 2.575, 1.018–6.514, p = 0.046; non-DM population, p = 0.393. The diabetes-fibrinogen interaction for the entire cohort was p = 0.101.

ConclusionsElevated fibrinogen is dose-dependently associated with END in patients with diabetes following acute ischemic stroke.